外源性胰岛素抗体综合征3例并文献复习

刘静; 臧丽; 谷伟军; 杨国庆; 陈康; 裴育; 杜锦; 巴建明; 吕朝晖; 窦京涛; 母义明

doi:10.3969/j.issn.2095-5227.2021.11.014

外源性胰岛素抗体综合征3例并文献复习

Exogenous insulin antibody syndrome: A report of 3 cases and literature review

摘要

摘要:
背景胰岛素是治疗糖尿病的有利武器，但外源性胰岛素可诱发机体免疫反应，导致外源性胰岛素抗体综合征(exogenous insulin antibody syndrome，EIAS)的发生。
目的探讨EIAS的临床特点及治疗方案。
方法分析3例不同EIAS患者的临床特点、治疗方案及预后。
结果 3例2型糖尿病患者均使用外源性胰岛素治疗，血清胰岛素自身抗体(insulin autoantibody，IAA)均阳性。病例1表现为高血糖伴酮症，经血浆置换及免疫抑制剂治疗后胰岛素用量减少、血糖改善；病例2及病例3表现为高低血糖交替，将胰岛素更换为口服降糖药后血糖控制平稳。病例1、病例3胰岛素水平正常；病例2胰岛素水平异常升高。
结论应用外源性胰岛素治疗的糖尿病患者可发生EIAS，IAA阳性，但临床表现及胰岛素水平各异，其治疗主要为调整饮食及使用降糖药物，严重者可选择血浆置换治疗。

Abstract:
Background The application of exogenous insulin is a critical part of treatment of diabetes. However, it may cause immune response and induce exogenous insulin antibody syndrome (EIAS).
Objective To investigate the clinical characteristics and treatment of EIAS.
Methods The clinical characteristics, treatment and prognosis of 3 patients with EIAS were analyzed.
Results The patients with type 2 diabetes were all treated with exogenous insulin. Their serum insulin auto-antibodies (IAA) were all positive. Case 1 presented with hyperglycemia and ketosis, his insulin dosage decreased and blood glucose was well controlled after plasma exchange and immunosuppression therapy; The other 2 patients manifested with alternation of hyperglycemia and hypoglycemia. The blood glucose was well controlled after changing insulin to oral hypoglycemic agents. The serum insulin level in case 1 and case 3 was within the normal range, and that in case 2 was abnormally elevated.
Conclusion The diabetic patients treated with exogenous insulin may suffer from EIAS, their IAA can be positive but the clinical manifestations and insulin levels are different. The main treatment strategies are changing insulin to oral hypoglycemic drugs and control diet, plasma exchange can be used for severe cases.

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